Under-recognition of pediatric hypertension diagnosis: Examination of 1 year of visits to community health centers

被引:15
作者
Moin, Anoosh [1 ,2 ]
Mohanty, Nivedita [3 ]
Tedla, Yacob G. [4 ]
Carroll, Allison J. [5 ]
Padilla, Roxane [3 ]
Langman, Craig B. [1 ,2 ]
Smith, Justin D. [5 ,6 ,7 ,8 ,9 ]
机构
[1] Ann & Robert H Lurie Childrens Hosp Chicago, Chicago, IL 60611 USA
[2] Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA
[3] AllianceChicago, Chicago, IL USA
[4] Northwestern Univ, Feinberg Sch Med, Dept Med, Chicago, IL 60611 USA
[5] Northwestern Univ, Feinberg Sch Med, Dept Psychiat & Behav Sci, Chicago, IL 60611 USA
[6] Northwestern Univ, Feinberg Sch Med, Dept Prevent Med, Chicago, IL 60611 USA
[7] Northwestern Univ, Feinberg Sch Med, Dept Med Social Sci, Chicago, IL 60611 USA
[8] Northwestern Univ, Feinberg Sch Med, Dept Pediat, Chicago, IL 60611 USA
[9] Univ Utah, Sch Med, Dept Populat Hlth Sci, Salt Lake City, UT USA
关键词
Childhood; community; diagnosis; elevated blood pressure; follow‐ up; hypertension; LEFT-VENTRICULAR HYPERTROPHY; HIGH BLOOD-PRESSURE; CHILDHOOD; CHILDREN; ADOLESCENTS; MANAGEMENT; UNDERDIAGNOSIS; PREVALENCE; PREVENTION; ADULTHOOD;
D O I
10.1111/jch.14148
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Pediatric hypertension is associated with significant target organ damage in children and cardiovascular morbidity in adulthood. Appropriate diagnosis and management per guideline recommendations are inconsistent. In this study, we determined the proportion of missed diagnosis of hypertension and prehypertension and appropriate follow-up in pediatric patients, stratified by sex, age, race/ethnicity, and weight status. Based on the electronic health record (EHR) data from eight federally qualified health centers, among 62,982 children aged 3 to 18 years, 6233 (10%) had at least one abnormal blood pressure (BP) measurement over twelve months. Among those children whose recorded BPs met the criteria for prehypertension (N = 6178), 14.6% had a diagnosis in the EHR. These children were more likely to be White and have obesity compared with children who met the criteria but were not diagnosed with prehypertension. Among those who met the criteria for hypertension (N = 55), 41.8% had a diagnosis of hypertension in the EHR. Being diagnosed with hypertension was not associated with any examined patient characteristics. Over eleven months, 2837 children had BP >= 95th percentile on >= 1 visit. Only 13% had guideline-adherent follow-up within 1 month and were more likely to be older, female, and of Hispanic ethnicity or "other" race. Over six months, 2902 children had BP >= 90th percentile on one visit. 41% had guideline-adherent follow-up within 6 months and were more likely to be older, of either White, Hispanic, Asian race, or Hispanic ethnicity. In a community-based setting, pediatric hypertension and prehypertension were persistently underdiagnosed with low adherence to recommended follow-up.
引用
收藏
页码:257 / 264
页数:8
相关论文
共 33 条
[1]  
[Anonymous], 2000, CDC growth charts: United States
[2]   Effect of microalbuminuria lowering on regression of left ventricular hypertrophy in children and adolescents with essential hypertension [J].
Assadi, Farahnak .
PEDIATRIC CARDIOLOGY, 2007, 28 (01) :27-33
[3]   Underdiagnosis of Hypertension Using Electronic Health Records [J].
Banerjee, Dipanjan ;
Chung, Sukyung ;
Wong, Eric C. ;
Wang, Elsie J. ;
Stafford, Randall S. ;
Palaniappan, Latha P. .
AMERICAN JOURNAL OF HYPERTENSION, 2012, 25 (01) :97-102
[4]  
Bello JK, 2017, GLOB PEDIAT HLTH, V4
[5]   Evaluation and Treatment of Hypertension in General Pediatric Practice [J].
Boneparth, Alexis ;
Flynn, Joseph T. .
CLINICAL PEDIATRICS, 2009, 48 (01) :44-49
[6]   Patient-, Provider-, and Clinic-Level Predictors of Unrecognized Elevated Blood Pressure in Children [J].
Brady, Tammy M. ;
Solomon, Barry S. ;
Neu, Alicia M. ;
Siberry, George K. ;
Parekh, Rulan S. .
PEDIATRICS, 2010, 125 (06) :E1286-E1293
[7]   Electronic health record with computerized decision support tools for the purposes of a pediatric cardiovascular heart disease screening program in Crete [J].
Chatzakis, Ilias ;
Vassilakis, Kostas ;
Lionis, Christos ;
Germanakis, Ioannis .
COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE, 2018, 159 :159-166
[8]   The impact of new guidelines on the prevalence of hypertension in children: A cross-sectional evaluation [J].
Condren, Michelle ;
Carter, Jessamyn ;
Mushtaq, Nasir ;
Puckett, Scott ;
Kezbers, Krista ;
Sabet, Samie ;
Morgan, Danielle .
JOURNAL OF CLINICAL HYPERTENSION, 2019, 21 (04) :510-515
[9]   A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: study protocol [J].
Cooper, Lisa A. ;
Marsteller, Jill A. ;
Noronha, Gary J. ;
Flynn, Sarah J. ;
Carson, Kathryn A. ;
Boonyasai, Romsai T. ;
Anderson, Cheryl A. ;
Aboumatar, Hanan J. ;
Roter, Debra L. ;
Dietz, Katherine B. ;
Miller, Edgar R., III ;
Prokopowicz, Gregory P. ;
Dalcin, Arlene T. ;
Charleston, Jeanne B. ;
Simmons, Michelle ;
Huizinga, Margaret .
IMPLEMENTATION SCIENCE, 2013, 8
[10]   Patterns of Care and Persistence After Incident Elevated Blood Pressure [J].
Daley, Matthew F. ;
Sinaiko, Alan R. ;
Reifler, Liza M. ;
Tavel, Heather M. ;
Glanz, Jason M. ;
Margolis, Karen L. ;
Parker, Emily ;
Trower, Nicole K. ;
Chandra, Malini ;
Sherwood, Nancy E. ;
Adams, Kenneth ;
Kharbanda, Elyse O. ;
Greenspan, Louise C. ;
Lo, Joan C. ;
O'Connor, Patrick J. ;
Magid, David J. .
PEDIATRICS, 2013, 132 (02) :E349-E355